肝脏血管平滑肌脂肪瘤的多层螺旋CT征象分析

Multi-slice CT manifestations of hepatic angiomyolipomas

目的分析肝血管平滑肌脂肪瘤(angiomyolipoma,AML)的多层螺旋CT(MSCT)表现,探讨其CT特征。方法回顾性分析8例(男性3例,女性5例)经手术病理证实的AML患者平扫和三期增强扫描的MSCT表现。结果8例中4例(50%)为肝混合型AML表现,平扫病灶由稍低密度软组织成分和低密度脂肪成分构成,边缘清楚。1例病灶为脂肪型AML表现,3例病灶为平滑肌型或血管型AML表现,增强扫描7例8个病灶动脉期软组织成分均明显强化;门脉期6个病灶密度高于周围肝实质;延迟期仍为高密度者3个。增强扫描病灶的脂肪成分均不同程度强化。6例的7个病灶周边出现扭曲血管与肝动脉相连;门脉期和实质期有3个病灶周围可见包膜样强化。3个病灶周围可见向肝静脉引流的引流静脉。结论多层螺旋CT可以展现肝血管平滑肌脂肪瘤的影像特征,对术前诊断有较高的价值。

Objective To investigate the multi-slice spiral CT manifestation and diagnostic value for hepatic angiomyolipomas. Methods Conventional CT scan and contrast enhanced scans with three phases were performed in 8 cases that were pathologically proved to be hepatic angiomyolipoma. Results On precontrast CT images, 4 cases contained both soft tissue and adipose tissue component, 3 cases consisted of soft tissue component merely, the last one appeared as adipose mass without soft tissue. The soft tissue component of 8 lesions had been markedly enhanced on the arterial phase, and 6 lesions were hyperdense on portal venous phase and 3 on parenchymal phase. In all the fat-containing lesions, the fat tissue appeared as inhomogeneous enhancement on the three phases, and 3 of them showed marked enhancement on the portal venous phase. On the arterial phase, 6 cases showed contorted feeding vessels and the hepatic vein acting as the drainage vessel of the mass could also be seen in 3 lesions on CT contrast scanning. Contrast-enhanced CT scan showed the peripheral rim of mass was markedly enhanced on the portal venous phase scans in 3 cases. Conclusion Multi-slice spiral CT may display the imaging features of hepatic angiomyolipomas, which findings will facilitate the differential diagnosis from other hepatic neoplasms before surgery.